H. Nelson-Williams1, J. Canner1, E. Schneider1, D. T. Efron1, E. R. Haut1, B. Shafiq1, A. H. Haider1, C. G. Velopulos1 1Johns Hopkins University School Of Medicine,Surgery,Baltimore, MD, USA
Introduction:
Younger, multi-trauma patients have improved survival when treated at a trauma center (TC). Many regions are now proposing that patients over age 65 be triaged to a higher level TC (HLTC) vs. lower level TC (LLTC), even for isolated injury, despite the absence of an established benefit in this elderly cohort. We therefore sought to determine if isolated hip fracture patients have improved survival outcomes based on trauma center level.
Methods:
A retrospective cohort of 1.07 million patients in The Nationwide Emergency Department Sample (NEDS) from 2006 to 2010 was used to identify 239,288 isolated hip fracture patients aged 65 to 105 years. Patients were stratified by AIS score. Multivariable logistic regression was performed controlling for age, sex, Charlson index, payor, zip code, teaching status, location, and region. The main outcome measures were in-hospital mortality and discharge disposition among patients admitted to a HLTC (Level I or II) vs. a LLTC center (Level III or non-designated TC).
Results:
Nearly all patients had an extremity AIS 3 (99.9%). Unadjusted logistic regression analyses revealed 8% higher odds of mortality (OR 1.08; 95% CI 1.00-1.16) and 10% lower odds of being discharged home (OR 0.90; 95% CI 0.80-1.00) among patients admitted to a HLTC versus LLTC. After controlling for patient and hospital-level factors, neither the odds of mortality (OR 1.06; 95% CI 0.97-1.15) nor the odds of discharge to home (OR 0.98; 95% CI 0.85-1.12) differed significantly between patients treated at a HLTC vs. LLTC. There were differences across payer (Table 1) and region for discharge home, with patients in the South and West more likely to be discharged home than to rehab.
Conclusion:
Among patients with isolated hip fractures, those admitted to a HLTC do not differ in mortality or discharge disposition from similar patients admitted to a LLTC. These findings may have important implications for trauma systems and triage protocols.
